IMD exclusion waiver approved for Oklahoma

Posted on: 12/23/20

The Centers for Medicare & Medicaid Services (CMS) on Dec. 22 approved Oklahoma’s application for a demonstration waiver of the Medicaid “IMD exclusion.”  The waiver will allow payment for treatment of serious mental illness and substance use disorder in psychiatric institutions.

The IMD exclusion is a long-standing policy that prohibits the use of federal Medicaid funds to pay for inpatient care for adults aged 21 through 64 in psychiatric hospitals, where more than 50% of the patients are hospitalized for mental disease.

States can obtain a waiver of the IMD exclusion if they meet a series of conditions targeted toward improving access to and quality of substance abuse disorder and mental health care, including increasing access to a full continuum of services, strengthening provider qualifications, requiring states and providers to institute evidence-based practices, and improving care coordination and transitions to community-based care.

The full demonstration approval document is posted here. (Rick Snyder)